=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053746180
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ELIZABETH WARD PHD, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2013
-----------------------------------------------------
Last Update Date | 09/09/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 HIGH ST
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02090-1100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-461-1121
-----------------------------------------------------
Fax | 781-461-1121
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 VILLAGE AVE
-----------------------------------------------------
City | DEDHAM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02026-4230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-461-1121
-----------------------------------------------------
Fax | 781-461-1121
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ELIZABETH WARD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 781-461-1121
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 9742
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------